New Minimally Invasive Surgery Sends Patients Home the Same Day

The Community Hospital is among the first hospitals in the area to offer a new minimally invasive surgery for the removal of parathyroid glands, enabling a patient to go home the same day, rather than a two-day hospitalization that is generally required.

The removal of the parathyroid gland is done to correct a potentially serious calcium imbalance caused by the overactivity of one or more of the glands located at the front of the neck. This condition, known as Hyperparathyroidism, slowly causes damage to the body as the abnormally high calcium levels destroy tissue, affecting major organs and bones.

Minimally Invasive Radioguided Parathyroidectomy (MIRP) uses a new technique that allows surgeons to more accurately pinpoint the overactive parathyroid gland so it can be more easily removed. This new surgery requires only a 1-inch incision in the neck, rather than a customary 3-4-inch incision. Another significant advantage is that the patient does not have to be put to sleep with general anesthesia.

Using conventional methods, an incision is made in the neck to locate and examine the four pea-size parathyroid glands deep within the neck. The larger incision also provides a better view of the vital structures around which the surgeon must operate. In most cases, only one gland is enlarged and needs to be removed, but finding it has been more challenging until now.

The new minimally invasive parathyroid surgery relies on new radioguided technology that allows the surgeon to identify which gland is diseased and its exact location within the neck. The identification is made possible through a sestamibi scan in which a small dose of radioactive material (the sestamibi) is injected into the body and is subsequently absorbed only by the diseased gland, essentially "lighting the way" for the surgeon.

These sestamibi scans have been used for several years at Community Hospital to give surgeons a kind of road map directing them to the area where the diseased gland is located. With this new surgery, the physician is guided directly to the gland by a small gamma detection probe. The probe acts like a Geiger counter in locating the radioactive material concentrated in the diseased gland.

With the radioguided surgery, the surgeon does not have to make a long incision to expose the whole neck area in order to locate and dissect the parathyroid gland. The whole operation now takes about 30 to 45 minutes to remove the gland, rather than the previous two to three hours required in conventional surgery for the removal and the exploration.

The minimally invasive surgery, which has cure rates as high or higher than the standard operation, is less traumatic for patients so they can more quickly resume their normal activities, said Dr. Nabil Shabeeb, president of the Community Hospital Medical Staff and the first surgeon to perform the surgery at the hospital.

About 80 percent of all patients who undergo parathyroid surgery might be candidates for having it performed using these minimally invasive techniques. Candidates for this procedure need to have a high quality sestamibi scan and require the removal of only one gland, Dr. Shabeeb said.

Hyperparathyroidism is usually caused by a noncancerous growth in one of the parathyroid glands. This gland produces too much of a hormone responsible for maintaining a correct balance of calcium in the body's bone and blood stream. Without this correct balance, too much calcium is taken from the bones and could contribute to the bone-thinning disorder osteoporosis. Too much calcium in the blood can contribute to the development of kidney stones and high blood pressure.

Since the disorder is more common in older individuals, surgical treatment is not always a viable alternative for individuals due to other medical conditions they may have, said Dr. Shabeeb. With the development of these radioguided surgical techniques, more people might be able to take advantage of this treatment option and be spared further complications from the disorder, he added.

"This is another example of the leadership our physicians and Community Hospital have taken in exploring a host of new minimally invasive techniques that are making surgery safer, less costly and less traumatic for patients," said Edward P. Robinson, administrator of The Community Hospital.

In the past two years, the hospital has introduced minimally invasive breast biopsies and minimally invasive heart surgery. Community Hospital is the only area medical center offering minimally invasive neurosurgery and a technique that eliminates the need to make a lengthy incision in the leg to obtain a vein for bypass graft surgery.